New Research Gives Insight To The Frequency Of 'Doctor Shopping' Occurring Within Prescription Monitoring Programs
Research presented at the American Academy of Pain Medicine's 26th Annual Meeting provides early published data analyzing information gathered from California's prescription monitoring program, known as the Controlled Substances Utilization Review and Evaluation System (CURES). The analysis found a two-fold increase in the likelihood of individuals receiving opioids from multiple providers or "doctor shopping" when they were also being simultaneously prescribed a single additional class of a controlled substances, such as benzodiazepines or amphetamines. When there was more than one additional drug class involved, there was a 13-fold increase for individuals seeing multiple providers. Over 34 states currently have prescription monitoring programs in place in an effort to address prescription drug abuse, addiction and diversion. One goal of the PMPs is to prevent individuals from "doctor shopping" where they obtain multiple prescriptions from multiple healthcare providers, which they subsequently fill at multiple pharmacies.
Third Party Reexamination Of Javelin Pharmaceuticals' Phase III Trial Data For Ereska Yields Statistically Significant Primary Endpoint
Javelin Pharmaceuticals, Inc. (NYSE Amex: JAV - News) announced that a reexamination conducted by a third party of pain score measurements from its Phase III study of Ereska™ (intranasal ketamine) showed that top line results for its primary endpoint were statistically significant. Previously, Javelin had reported that the top line results for its primary endpoint were not statistically significant. The previously disclosed top line results, based upon data captured by an external vendor, had inconsistencies whose presence was verified by a third party biostatistics company engaged by Javelin that thoroughly reexamined the trial's conduct and the initial primary analysis. The third party's correction of these inaccuracies yielded today's results. As previously disclosed, global patient satisfaction scores for Ereska were also statistically superior to placebo. All other secondary endpoints, while numerically superior to placebo, did not achieve statistical significance. Ereska, a nonopioid analgesic, was generally well tolerated in the trial.
About one-third of doctors and their patients with diabetes do not see eye to eye on the most important health conditions to manage, according to a survey by the University of Michigan Medical School. While both groups frequently ranked diabetes and hypertension among their top concerns, 38 percent of doctors were more likely to rank hypertension as the most important, while only 18 percent of diabetics said it was the most important. Patients were also more likely to prioritize symptoms such as pain and depression. The findings appear in the current issue of the Journal of General Internal Medicine and may shed light on why some patients manage their diabetes so poorly. "If a patient and their doctor do not agree on which of these issues should be prioritized, it will be difficult for them to come up with an effective treatment plan together, " says lead author Donna M. Zulman, M.D., a Robert Wood Johnson Clinical Scholar at the University of Michigan Medical School and researcher at the Veterans Affairs Healthcare System in Ann Arbor.
Patients undergoing knee or hip replacements recover more quickly when treated with targeted pain-blocking medications that may eliminate the need for general anesthesia during surgery and intravenous narcotics drugs after surgery. The February issue of Mayo Clinic Health Letter explains the newer pain management options and their benefits. A decade ago, patients undergoing hip or knee replacements were almost exclusively given general anesthesia during surgery and intravenous narcotic pain medications afterward. This approach works for most people and still is commonly practiced. But both general anesthesia and intravenous narcotic drugs can cause nausea, vomiting, grogginess, decreased bowel function and other side effects. In the early 2000s, Mayo Clinic anesthesiologists began developing new anesthesia protocols for joint replacement surgery that used known anesthetic and pain relief techniques in new combinations. Their goal was to eliminate the need for general anesthesia and intravenous narcotics and the resulting side effects.
New Clinical Research Study Focuses On New Treatment Option For Hard-to-Diagnose Painful Bladder Syndrome
A clinical research study is being conducted for patients with Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS), a chronic bladder disorder characterized by intense pelvic pain, urinary frequency-urgency, and pain during sexual intimacy. It is estimated that as many as 1.3 million people in the U.S. have been diagnosed with this disease and many more remain undiagnosed. There can be various underlying reasons why many people are undiagnosed: First, public awareness about IC/PBS is very low. Second, IC/PBS can be hard to diagnose because its symptoms mimic those of other painful bladder conditions. In women, the symptoms of chronic pelvic pain, urgency, and frequency may be misdiagnosed as a recurring urinary tract infection, overactive bladder or endometriosis. In men, the symptoms may mimic medical problems such as chronic nonbacterial prostatitis or benign prostatic hypertrophy (enlarged prostate). An accurate diagnosis of IC/PBS is most often confirmed after numerous medical tests have been conducted.
Research led by a scientist at Barrow Neurological Institute at St. Joseph's Hospital and Medical Center has opened the door for the advancement of a new category of painkillers, called TRPV1 antagonists. These drugs block the transient receptor potential vannilloid-1 (TRPV1) channel, which is the same receptor responsible for the sensation of hotness from hot peppers. However, clinical trials have revealed that TRPV1 antagonists cause hyperthermia - a dangerous, fever-like rise in body temperature. Research has shown that TRPV1 can be activated by several stimuli, including "pepper-like" chemicals, high temperatures and protons. The same channel is responsible for pain caused by these diverse stimuli. For a number of years scientists have focused on the development of TRPV1 antagonists, but have been stymied by the dangerous hyperthermia side effect. The groundbreaking project to eliminate the side effect was led by Andrej A. Romanovsky, MD, PhD, at Barrow and included researchers from Amgen and Arizona State University.
Neurofibromatosis, also known as NF, is a genetically inherited disorder of the nervous system (brain and spinal cord) which mainly affects the development of nerve (neural) cell tissues, causing tumors (neurofibromas) to develop on nerves, and may cause other abnormalities. The tumors may be harmless, or may compress nerves and other tissues and cause serious damage. In some rarer cases the tumors may become cancerous. Neurofibromatosis affects all neural crest cells (Schwann cells, melanocytes, endoneurial fibroblasts). Elements from these cells proliferate in excess throughout the whole body, resulting in the formation of tumors, and abnormal function of melanocytes, causing disordered skin pigmentation. Melanocytes are pigment-producing cells in the skin, hair and eye that determine their color. The tumors may also cause bumps under the skin, colored spots, bone problems, pressure on spinal nerve roots, as well as other neurological problems. Neurofibromatosis may affect the bones, causing severe pain.
Neurotoxins from cone snails and spiders help neurobiologists Sebastian Auer, Annika S. Sturzebecher and Dr. Ines Ibanez-Tallon of the Max DelbrГ ck Center for Molecular Medicine (MDC) Berlin-Buch, Germany, to investigate the function of ion channels in neurons. Ion channels in the cell membrane enable cells to communicate with their environment and are therefore of vital importance. The MDC researchers have developed a system which for the first time allows the targeted, long-lasting investigation of ion channel function in mammals and also the blockade of the ion channels with neurotoxins. In transgenic mice they succeeded in blocking chronic pain by introducing a toxin gene into the organism ( Nature Method, doi:10.1038/NMETH.1425)*. There are approximately 500 species of cone snails, each producing 50 - 200 different conotoxins. A similar number of peptide toxins are produced by snakes, spiders, sea anemones, scorpions and other venomous animals. The animals use the neurotoxins to paralyze their prey.
Clinical Study: Biologic Grafts Reduce Postoperative Pain While Creating A Repair As Durable As Synthetic Mesh In Treating Inguinal Hernias
Results from a clinical study led by Luca Ansaloni, M.D., showed that Cook Medical's Biodesign Inguinal Hernia Graft causes less postoperative pain and discomfort while creating a repair as durable as synthetic mesh when used in Lichtenstein's hernioplasty procedures. As published in a recent issue of the American Journal of Surgery, the three-year, 70-patient study determined that patients treated with Biodesign Inguinal Hernia Graft experienced a lower level of postoperative pain as compared with synthetic mesh-based procedures. The randomized, double-blind inguinal hernia study examined the efficacy of the Biodesign Inguinal Hernia Graft in treating 35 men compared to 35 men treated with synthetic mesh. Research findings showed that 11 percent of patients treated with synthetics experienced chronic postoperative pain that limited daily activities, most often resulting from the mesh characteristics as opposed to surgical technique. By contrast, patients in the study treated with Biodesign Inguinal Hernia Graft experienced a lower degree1 of postoperative pain both at rest and when coughing or moving.
The brains of people under anesthesia respond to stimuli as they do in the deepest part of sleep - lending credence to a developing theory of consciousness and suggesting a new method to assess loss of consciousness in conditions such as coma. Scientists at the University of Wisconsin School of Medicine and Public Health, led by brain researcher Fabio Ferrarelli, reported their findings in this week's edition of the Proceedings of the National Academy of Science. The group gave the anesthetic midazolam, commonly used at lower doses in "conscious sedation" procedures such as colonoscopies, to volunteers. Then they used transcranial magnetic stimulation (TMS), a noninvasive technique to stimulate the brain cortical neurons from the scalp, in combination with electroencephalography (EEG), which recorded the TMS-evoked brain responses. What they found is a pattern that looks much as it does when the brain is in deep, non-rapid eye movement (non-REM) sleep, another condition when consciousness fades.